<?php require_once '../head.php'; ?>
<?php require_once '../bg/header.php'; ?>


<div class="or-spacer">
        <div class="mask"></div>
        <span><i>AA</i></span>
</div>
<div id="" class="content_wrapper">
    <form action="../process_form.php" method="post" id="form_page_content" class="inner_content stitcher">
        <label for="form_name">Вашето Име</label> 
        <input id="form_name" type="text" name="name">
        
        <label for="form_email-address">Вашият Имейл Адрес</label> 
        <input id="form_email-address" type="text" name="email-address">
        
        <label for="form_phone">Вашият Телефонен Номер</label> 
        <input id="form_phone" type="text" name="phone">
        
        <label for="form_vrd">Регистрационен номер</label> 
        <input id="form_name" type="text" name="vrd">
        <label for="form_vrd_file">Снимка на голям талон</label> 
        <input id="form_vrd_file" type="file" name="vrd_file">
        
        <label for="form_name_recipient">Име на получателя на документите</label> 
        <input id="form_name_recipient" type="text" name="name_recipient">
        
        <label for="form_phone_recepient">Телефон на получателя</label> 
        <input id="form_phone_recepient" type="text" name="address">
        
        <label for="form_address">Пощенски адрес на получателя</label> 
        <input id="form_address" type="text" name="address">
        
        <hr>
        <input id="send_form_but" type="submit" name="submit" value="Изпрати">
        
        
    </form>
</div>

<?php require_once '../foot.php'; ?>
